By TESS VRBIN | Arkansas Advocate
All 75 counties in Arkansas have at least one ambulance desert, meaning it takes paramedics longer than 25 minutes to drive to some residents’ homes, according to a nationwide study published in May.
Several factors, particularly limited public and private revenue in sparsely populated areas, drive this scarcity of potentially life-saving health services, according to medical professionals and elected officials throughout Arkansas.
“It’s the whole medical institution that’s in distress, and the most visible part of that is the ambulance service and their ability to serve the community,” said Mayor Doug Hutchens of Lincoln, a small city in Washington County that sits in the middle of an ambulance desert.
In the 41 states that provided data to researchers, 4.5 million people live in ambulance deserts — including 195,159 Arkansans‚ mostly in rural counties — according to the study from the Maine Rural Health Research Center at the University of Southern Maine.
Adding one paramedic ambulance to a community costs about $6,000 per year, said Gary Padget, the owner of Southern Paramedic Service. Many rural areas barely have the tax base to fund the ambulance services they do have, so paying for more services is not a viable option, he said.
“You say we have this area that’s very underserved — well, it’s probably underserved because there are very few people here,” Padget said. Southern Paramedic serves six counties, including Monroe and Prairie, two of the least populous in Arkansas, with fewer than 10,000 residents apiece as of the 2020 U.S. Census.
Ken Kelley, the owner and CEO of ProMed Ambulance Service, said one community without an ambulance asked him to provide services. He could not grant the request because the community did not have the existing funds or a plan to subsidize the cost, he said.
ProMed is based in El Dorado and serves seven counties, and Kelley has been a paramedic in Arkansas for more than 30 years. He said has seen how changes in the state’s population relate to the availability of paramedic services, since areas with larger populations have more calls for help and therefore receive more resources.
“As populations shift, the need to have ambulances goes along with the need to have revenue, so some communities are having to make hard decisions about ‘Are we going to support this or not?’” Kelley said.
Ambulance services cannot bill patients unless they have transported them to a hospital. During the COVID-19 pandemic, people called ambulances less frequently because they were afraid to go to hospitals, Hutchens and Kelley both said.
“A large percentage of EMS calls are unnecessary,” Hutchens said. “If somebody gets a cold, they call the ambulance.”
Another blow to ambulance revenue during the pandemic came from people who did call ambulances getting treated at home, so paramedics did not get paid for this work, Hutchens said.
Now, call volume is at or above its pre-pandemic level, and Lincoln paramedics are working enough overtime hours to take a chunk out of the city budget, Hutchens said.
Ambulance services in Washington County prioritize Fayetteville as the largest city, while cities several miles outside the urban area, like Lincoln, are a lower priority, Hutchens said. Lincoln sometimes has an ambulance posted at one of its fire stations, but that unit often has to back up services in other cities.
“We’re without an ambulance longer per day substantially than we are with one, and it’s not unusual for our ambulance to go on a call within our area and have to transport [someone to a hospital] and not have an ambulance to back up our area until the next shift the next day,” Hutchens said.
Padget and Hutchens both said emergency management services have rarely qualified for federal financial assistance, including American Rescue Plan Act funds, which are aimed at COVID-19 relief.
Applying for grants is a skill that people in rural government positions might not have in terms of time and resources, Padget said.
“It’s a challenge to even get good water and sewer systems in their communities, so ambulances just kind of take the back burner and always have,” he said.
Additionally, about 70% of Southern Paramedic’s revenue comes from “our most vulnerable population,” Padget said, meaning low-income people on Medicaid and elderly people on Medicare.
Not only do these groups need ambulance services more often than others, Padget said, but Medicare and Medicaid underpay private ambulance companies by more than half of what the actual services cost.
“If you’re breaking even or losing a little money on your calls, and 70% are funded by government programs, you’re in trouble pretty quick,” he said.
Remedies and other obstacles
Some localities in Arkansas subsidize their ambulance services, Kelley said, including Perry County, one of ProMed’s clients.
The county used a sales tax initiative to support a second ambulance station, which Kelley said is important for residents that live in the Ouachita National Forest.
“Perry County has a relatively low call volume, but due to the terrain challenges of getting to Little Rock and Hot Springs hospitals, they have two ambulances there,” Kelley said.
Meanwhile in the Delta, which has been steadily losing population according to census data, Phillips County has made budget cuts due to its declining tax base, District 8 Justice of the Peace Martin Rawls said. Western and southern Phillips County, including Rawls’ hometown of Marvell, are far enough away from the hospital in Helena-West Helena to be in ambulance deserts, according to the study.
Rawls said he worries for the elderly population in those areas, but the county is not in a financial position to get more ambulance services.
Some rural areas might have outdated GPS systems that misdirect ambulances, which used to happen in Bradley County, said state Rep. Jeff Wardlaw, R-Hermitage.
Two people in the county died of heart attacks in recent years because ambulances arrived too late, so the emergency management contractor not only updated its software but also hired drivers that were familiar with the area, Wardlaw said.
“After we talked to them and threatened them with a new vendor, they hired more local people who know the roads of the county, and the response times are a lot better today,” said Wardlaw, who works in medical sales and equipment delivery. However, the paramedic industry as a whole is experiencing a staff shortage, Hutchens and Kelley both said.
“In the stress of the COVID period, a lot of people just left the field,” Hutchens said.
The Arkansas EMT Association had its annual conference in Hot Springs from Thursday to Sunday, and Kelley said “front-end recruitment” of new paramedics was a high priority. Kelley is the governmental liaison for the Arkansas Ambulance Association, and he said the organization has been collaborating with state lawmakers to draw up legislation that would increase funding for ambulance services in rural areas.
“We didn’t run it this year because it wasn’t ready for primetime yet, but we’re working with legislators that want to get solutions to this,” Kelley said.